RCM tip of the day: Use technology as part of a denials program

Hospitals continually seek to improve their approach to managing claim denials. To achieve this, they should invest in an effective denials program to prevent denials and ensure they recoup maximum revenue for services, according to Amber Luliano, product manager of denial management at Waystar.

"By not committing to a robust denials program, organizations can miss prime opportunities to strengthen revenue integrity and speed cash flow, leaving critical money on the table. An effective program involves a change in mindset, moving away from reacting to denials after they occur to proactively identifying patterns and implementing targeted performance improvement strategies to address issues and keep them from recurring," she shared with Becker's Hospital Review.

Ms. Iuliano also recommended focusing on revenue cycle management technology to prevent denials.

This technology "can play a key role in shifting an organization's denials approach," she said. "For example, a solid RCM system can improve accuracy when capturing patient demographic and registration information, reducing the likelihood of denials tied to incorrect patient identification. Automated insurance verification tools can ensure patients have the necessary coverage for the care they receive, limiting lack of coverage denials."

"Digging deeper, when an RCM tool offers data analytics and predictive modeling, it can identify more global denial trends and patterns, helping an organization uncover the root causes of recurring issues," Ms. Iuliano continued. "RCM tools can also refine an organization's communication about denials, offering performance dashboards and payer scorecards that clearly illustrate the current state and prompt staff to rapidly respond to performance dips."

Additionally, Ms. Iuliano advocated for a system that automates appeals so hospitals "can swiftly send information to payers, check on the status of appeals, follow up on outstanding queries and receive funds. Through this technology, organizations can optimize the appeal process and ensure they receive all the money to which they are entitled."

If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.   

 

 

 

 

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